stars Archives - Page 18 of 19 - The Healthcare Labyrinth

December 7, 2023

December 7, 2023 No Comments

United Health Foundation Says Chronic Conditions Rising The United Health Foundation released a study that concludes chronic conditions are rising in the U.S. It also released its annual “America’s Health Rankings” report, which tracks health across the country based on 87 measures and 28 data sources. United finds that persons with multiple chronic conditions has reached their highest levels since they were first tracked. Mental health and diabetes have risen. It also found health condition disparities exist for asthma, COPD, and diabetes. United also found that more people have multiple co-morbidities. United calls for investments in care management as well as health equity. As I note in my book, The Healthcare Labyrinth (available on this website), one of America’s key problems is a lack of investment in health, wellness, and care management. Other developed nations concentrate resources here and have much better outcomes, fewer people with disease states and conditions,

Republicans Have a Compassion Gap But Trump Gives Democrats Momentum on Healthcare Anyway

December 7, 2023 No Comments

Former President Donald Trump recently brought up the possible repeal of the Affordable Care Act (ACA) and has put his (and my) party in a bind. Republicans suffered at the polls on the very issue Trump has resurrected. Why is he raising the status of the landmark act again? In a post on Truth Social on November 25, Trump declared: “The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives.” He clearly caught his party by surprise. You could hear the collective signs and groans coming from Capitol Hill Republicans who survived the issue in the past. After some criticism, Trump sought to clarify his remarks but actually reiterated his stand. On November 29 on Truth Social, Trump stated: “I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!” Fellow candidate and FL Gov. Ron

December 6, 2023

December 6, 2023 No Comments

Affordable Care Act 2025 Rule And Ongoing Press On Trump Repeal Remarks While we have already covered the proposed 2025 Exchange rule, this article from Kaiser Health News discusses the rule as well as some of the history of the Affordable Care Act under Trump and later Biden. #aca #obamacare #exchanges #medicaid Link to Article Drug Donations Help The Uninsured and Low Income Great Kaiser Health News article on drug donation programs in states. Helping to save lives and reduce healthcare costs. #drugpricing Link to Article Exchange Enrollment Doing Very Well But Not Picking Up Many Losing Medicaid Coverage Nearly 7.3 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period (OEP) opened on November 1. It runs through January 15, 2024. The numbers from the Centers for Medicare and Medicaid Services (CMS) represents activity through December 2 (Week 5)

December 5, 2023

December 5, 2023 No Comments

Is Interest In ACA Truly Fading? The Kaiser Family Foundation (KFF) poll says that the ACA and generally healthcare are fading as issues in the 2024 campaign. The poll was done before Donald Trump’s remarks on the Affordable Care Act (ACA). But let me take a slightly contrarian view here. As the poll notes, about half of the 1,401 people surveyed said the future of the ACA is a key topic. About 70% of Democrats thought so and 32% of Republicans thought so. To me, in a close election, 32% of Republicans thinking the ACA is significant is, well, significant. In a close election, how do you win if one-third of Republicans and a greater percentage of independents care about an issue? KFF poll here: https://www.kff.org/health-reform/press-release/poll-by-a-wide-margin-democratic-voters-now-care-more-about-the-affordable-care-act-than-republican-voters-do-and-voters-trust-democrats-more-than-republicans-to-handle-its-future/ #aca #obamacare #exchanges #medicaid #healthcare #healthinsurance #healthcarereform Link to Article CVS Follows Other Large PBMs in Reforming Reimbursement CVS unveiled Tuesday that it will

December 4, 2023

December 4, 2023 No Comments

U.K. National Health Service Has New Drug Pricing Deal An article in The Economist discusses the United Kingdom’s new drug pricing deal. As we know, all other developed nations negotiate and set prices globally, as Great Britain does. The Inflation Reduction Act’s Medicare drug price negotiation will slowly bring some of what other developed nations have. In fact, we have some in force now. Key points from the article: Still, the U.K. says it is getting hurt by high-cost cancer and other drugs. The U.K. and other systems work and should be fully in place in America. (Article may require a subscription.) #drugpricing #medicare #partd #uk #nhs Link to Article Good Argument For Debt and Entitlement Commission The Heritage Foundation, a conservative think tank, has a great analysis of why a debt and entitlement commission is a good idea. It is very factual. A few points: #medicare #medicareadvantage #debt #deficit

Medicare Advantage Insurers Focusing On Special Needs Plans And Growth Shows It

December 4, 2023 No Comments

While Medicare Advantage (MA) has seen huge increases in enrollment since the beginning of the decade, forecasts suggest that enrollment growth will be reduced moving forward. Many things factor into the slowdown, including a new rate environment, poor Star performance, and reaching saturation in certain areas of the country. Nonetheless, MA continues to be a strong program and the most-lucrative place to be if you are an insurer. One segment of the MA program, Special Needs Plans (SNPs), however, are destined to continue to grow significantly moving forward. This is driven in part by policies from the Centers for Medicare and Medicaid Services (CMS) and the significant financial opportunity plans see. As of November 2023, SNP and related program enrollment stood at over 6.6 million. That is a 15% growth since January 2023. There are three types of SNPs: (1) Institutional SNPs or I-SNPs (the individual is a resident of

December 1, 2023

December 1, 2023 No Comments

Cigna-Humana Deal Could Pass Muster While federal and state regulators will look closely and potentially oppose a combination, experts seem to think that the Cigna-Humana merger could eventually go through. As I have indicated as well, the company profiles are quite different than earlier deals that fell through. #cigna #humana #mergers #acquisitions Link to Article Our Primary Care Problem The article makes a couple key points. It notes the vast difference between primary care and specialist compensation. We are clearly over-specialized in the United States. It also discusses an important bill sponsored by Sen. Bernie Sanders, I-VT, and Sen. Roger Marshall, R-KS, that would invest $26 billion to bolster primary care, increase training opportunities for doctors and nurses, and expand access to community health centers. We do need to invest in so many ways in primary care so we can pivot healthcare from utilization management to care management. #utilizationmanagement #caremanagement #healthplans

November 30, 2023

November 30, 2023 No Comments

Walgreen’s Launches Drug Tool Similar to others, Walgreen’s has launched a drug price transparency and saver tool for its customers. No monthly fee applies. #drugpricing #walgreens Link to Article Investors Look To Medicaid Managed Care Interesting article on investors now looking to Medicaid managed care as the Medicare Advantage market cools and is dominated by big players. While Medicaid margins are skinnier, Medicaid has been growing and states have been pushing more and more lives into managed care. Rolls will drop with redeterminations coming out of COVID, but aging and long-term care remains a big opportunity for plans and investors. (Article may require subscription.) #medicaid #managedcare Link to Article United Details 2024 Outlook Healthcare behemoth United Healthcare detailed its outlook for 2024. Trends it sees will likely match the industry. United sees slower growth in Medicare Advantage, continued efforts to employ physicians, and increased investments in technology. Additional article here:

American Healthcare Is A Huge Outlier In Terms Of Costs and Outcomes

November 30, 2023 No Comments

I am writing this blog from the United Kingdom on the occasion of the 75th anniversary of the National Health Service (NHS). The British newspapers this year, as they were five years ago for the 70th Anniversary, were filled with a curious mix of messages about the NHS. On the one hand, Britons defend the NHS and take pride in the system that has been built over the last 75 years. The NHS is always at or near the top of the most important issues at election time. At the same time, Britons are frustrated with many elements of the system, including long wait times and the hoops that must be jumped through for certain services as well as notable staff shortages and other deficiencies. Some blame privatization over the past few decades as well as the miserly increases given to the NHS during the conservative government’s tenure over the

November 29, 2023

November 29, 2023 No Comments

Cigna and Humana Exploring A Merger Stunning news on the health plan front with speculation that Cigna and Humana are entertaining a merger. This explains reports not too long ago that Cigna was thinking about giving up its Medicare Advantage (MA) line of business. The merger seems like a match made in heaven. Cigna is a commercial powerhouse, but its MA line is much smaller than Humana’s. Its MA line is struggling from a Star perspective. It sold its only Medicaid assets a few years ago. Humana is second only to United in MA and has a growing Medicaid line. Both plans have some provider assets as well. And Express Scripts, Cigna’s PBM and one of the nation’s big three, would be a huge asset for Humana. Humana has a subscale PBM asset. Earlier mega mergers (Aetna-Humana and Cigna-Anthem) fell apart due to federal and state pushback and footprint overlaps.

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